Trump announces deal with Lilly, Novo to expand access to weight loss drugs, cut prices

By Daniel Payne and Elaine Chen – The Trump administration announced a deal Thursday to expand access to popular obesity drugs made by Novo Nordisk and Eli Lilly — offering more coverage for Medicare and Medicaid beneficiaries and lowering the prices across the board. The administration argued that giving millions more people access to these drugs represents a major victory in the fight against chronic disease. The precise timeline for the coverage expansion and the extent of who will gain access remain unclear." Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Discounted Access and Expanded Coverage Through Medicare and Medicaid: The U.S. government has reached agreements with drugmakers Novo Nordisk and Eli Lilly to offer significant discounts on weight loss and diabetes drugs such as Wegovy and Zepbound. Medicare and Medicaid will begin covering these treatments for certain individuals with obesity and related health risks starting in 2026, with copays as low as $50. These agreements are intended to expand access, especially for individuals at high metabolic or cardiovascular risk, although state Medicaid programs must opt in to participate.

2. Public Health and Economic Implications: By increasing affordability and access to GLP-1 drugs, the deals could help address obesity-related chronic diseases and yield long-term savings for the healthcare system—estimated at $175 billion over time. Early data suggests potential benefits to cardiovascular and mental health. However, experts note concerns about equitable access, sustainability of voluntary programs, and the need for more research into long-term use and outcomes of the drugs.

3. Strategic Industry-Government Deals with Broad Implications: The agreements include additional concessions from drugmakers—such as selling their full drug portfolios at international benchmark prices to Medicaid and offering discounted direct-to-consumer options. In return, companies receive regulatory benefits like FDA priority review vouchers and tariff relief. While the deals may signal a shift in U.S. drug pricing policy, lack of transparency and uncertainty around how prices will affect broader markets remain unresolved.

Where Do Our Health Insurance Premiums Go?

By Rachel Madley, PhD – As open enrollment begins and Congress remains deadlocked on whether to extend the ACA’s enhanced premium subsidies, one question looms large: Where does all the money we pay for health coverage actually go? It’s a fair question. Premiums and out-of-pocket costs have risen relentlessly over the past decade. Since the Affordable Care Act was fully implemented, the average premium for an ACA marketplace plan has doubled, and the average deductible for a Silver plan has increased by 92%. Every year, families pay more, yet the coverage often feels thinner. Read Full Article...

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1. Insurers’ Profit Growth Outpaces Justified Cost Increases: While health insurance companies often justify annual premium increases by citing rising medical and pharmacy costs, financial filings show that the seven largest publicly traded insurers — including UnitedHealth Group, CVS/Aetna, Cigna, Elevance, Humana, Centene, and Molina — collectively earned over $500 billion in profits between 2014 and 2024. These profits represent money paid by individuals, employers, and taxpayers for coverage, but not used for actual medical care. For context, that amount could fund enhanced Affordable Care Act subsidies for the next 10 years at an estimated cost of $350 billion.

2. Significant Spending on Stock Buybacks and Lobbying: Between 2014 and 2024, these same insurers spent $146 billion on stock buybacks — a practice that increases executive compensation and share prices but does not reduce premiums, expand provider networks, or improve patient care. According to the article, this amount could have provided premium-free health insurance to over 5 million families for an entire year, based on the projected average cost of an employer-sponsored plan ($27,000) in 2026. In addition, they spent $618 million on lobbying activities, aiming to influence federal policy in ways that protect profits rather than lower consumer costs.

3. Calls for Policy Reform to Restrict Use of Premium Dollars: The article argues that instead of asking families and taxpayers to pay more, policymakers should hold insurers accountable for how they use premium dollars, particularly regarding practices that do not improve health outcomes. It emphasizes that current regulations allow insurers to spend both premium and taxpayer money on shareholder enrichment and lobbying — expenditures that contribute to rising costs rather than better care. The author suggests that eliminating these uses of funds could be a foundational step toward containing healthcare costs and redirecting existing resources toward universal or more affordable coverage.

Idaho orders insurers to halt restrictions on Medicare Advantage applications

By Kenneth Araullo – The Idaho Department of Insurance has issued cease-and-desist orders to PacificSource Community Health Plans, UnitedHealthcare of the Rockies, and Care Improvement Plus South-Central Insurance Co., citing allegations that the companies intentionally restricted access to Medicare Advantage applications due to concerns about enrollment numbers. According to the department, the investigation began in September after reports surfaced that the insurers were limiting both online and paper applications for Medicare Advantage plans. Read Full Article...

HVBA Article Summary

1. Insurers Discouraged Medicare Advantage Enrollment in Idaho: In Idaho, insurance agents reported limited access to paper applications and the elimination of commissions for Medicare Advantage plans, even though those commissions were included in approved premiums. According to state regulators, companies such as UnitedHealthcare and PacificSource acknowledged these actions were not cost-saving measures but were deliberately intended to suppress enrollment due to concerns over managing high volumes of new enrollees.

2. State Regulators Intervene to Protect Medicare Access: The Idaho Department of Insurance issued emergency orders requiring insurers to stop any actions that restrict or obscure access to Medicare Advantage plans—whether through paper or online channels—and to end any disincentives for agents selling these plans. PacificSource was explicitly directed to halt contract changes designed to withhold commissions, which the regulator said were aimed at manipulating market participation ahead of the December 7 open enrollment deadline.

3. Medicare Advantage Market Faces Broader Challenges Nationwide: The situation in Idaho mirrors growing instability in the Medicare Advantage sector across the U.S. Major insurers are reducing plan offerings due to declining federal reimbursements and increasing regulatory constraints. UnitedHealthcare announced a large-scale withdrawal from 16 markets, aiming to cut Medicare Advantage membership by 600,000. Meanwhile, Humana suffered a legal setback over federal star ratings that could cost the company billions in bonus payments, highlighting the financial pressures facing the industry.

Nearly 40,000 People Urge Employers to Cover Comprehensive Obesity Care

By Marissa Plescia – Almost 40,000 people have signed a petition calling on employers to provide comprehensive obesity care coverage. The petition came from the Alliance for Women’s Health and Prevention’s (AWHP) EveryBODY Covered Campaign, which launched in February of 2024 and seeks to expand coverage of obesity care. Specifically, the petition makes three demands of employers. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Petition’s Three Core Demands for Employers: The petition urges employers to recognize obesity as a chronic health condition influenced by multiple factors beyond personal control, review and improve employee benefits to support obesity care—covering FDA-approved medications such as GLP-1s, bariatric surgery, behavioral interventions, and nutrition services—and clearly communicate these benefits to administrators. It also calls on employers to combat weight bias throughout the organization by educating employees, using person-first language, and providing accommodations for workers living with obesity.

2. Health and Economic Context of Obesity: The Association for Women’s Health Professionals (AWHP) highlights that obesity is linked to more than 200 health complications. Many health plans still exclude or restrict coverage for obesity care, despite its medical classification as a chronic yet treatable condition. Women with obesity earn 9% less on average and are less likely to be promoted than women without obesity, underscoring the broader social and economic impacts.

3. Coverage Trends and Employer Implications: The petition’s release follows decisions by some insurers, including Blue Cross Blue Shield of Massachusetts and Harvard Pilgrim Health Care, to limit GLP-1 coverage for weight loss, though maintaining it for diabetes. A Business Group on Health survey found that 73% of self-insured employers cover GLP-1s for obesity, while 99% cover them for diabetes. Advocates, including Cassie Maxwell from West Virginia, emphasize that expanding comprehensive obesity coverage is both a health equity issue and a workforce productivity investment.

Half of consumers give overall U.S. health insurance system a 'C' grade

By Alan Goforth – With open enrollment under way and partisan bickering heating up during the government shutdown, Americans have conflicting views about the U.S. health care system. Despite half of consumers giving the overall U.S. health insurance system a grade of C and three-fourths having delayed or skipped medical care because of out-of-pocket costs, nearly 9 in 10 are satisfied with their own insurance. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. High Satisfaction but Affordability Concerns Remain: A significant majority (88%) of Americans report satisfaction with their health insurance coverage, especially Medicare enrollees. However, affordability continues to be a critical issue, with premiums identified both as the most and least satisfying aspect by nearly equal proportions (39% vs. 37%). This contrast suggests that while many are content with their overall coverage, the cost of maintaining it creates financial strain for a sizable portion of the population.

2. Confusion and Interest Around GLP-1 Drug Coverage: More than half of Americans mistakenly believe weight loss drugs like GLP-1s are commonly covered by insurance, and 75% would be interested in using them if they were. Over a third of that group would pay $500+ out of pocket monthly, highlighting a gap in understanding and willingness to invest in such treatments. This points to a growing demand for insurance providers to clarify and potentially reevaluate their policies regarding emerging medical therapies.

3. Openness to AI and Flexible Employer-Based Options: Consumers show growing interest in technological and flexible solutions: over 70% are open to using AI for insurance enrollment, and many with employer-based coverage favor portable insurance and stipends for ACA market plans. This indicates a desire for greater autonomy and efficiency in choosing and managing health plans. The trend reflects shifting expectations for convenience, personalization, and continuity of coverage regardless of employment status.

Armed to the teeth: Comprehensive benefits coverage includes dental care

By Manish Naik – As employers seek to enhance the well-being, productivity and overall vitality of their workforce, offering comprehensive dental coverage is a crucial component of employee benefits that can't be overlooked. A recent report by Cigna Healthcare Dental underscores the significant links between oral health, overall health and employee performance. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Oral Health Impacts Overall Health: Research continues to show that poor oral health is connected to broader systemic health issues, including cardiovascular disease, diabetes, and mental health disorders. Conditions like periodontitis can trigger chronic inflammation and facilitate the spread of harmful bacteria throughout the body, contributing to or worsening these systemic illnesses. Maintaining good oral hygiene is therefore not only important for dental health but also essential for preventing more serious chronic health problems.

2. Access to Dental Care is Unequally Distributed: Social determinants—such as income, geography, and race—affect individuals' ability to access dental care. People in rural or underserved urban areas often face shortages of providers or dental care deserts. Addressing these barriers through comprehensive dental coverage can lead to more equitable health outcomes across diverse populations.

3. Employers Play a Vital Role in Improving Dental Health Access and Outcomes: By offering benefits like preventive care incentives, discounted oral hygiene tools, educational programs, teledentistry, mobile dentistry, and financial assistance, employers can help employees maintain better oral health. This not only benefits employees' health but also improves productivity, reduces absenteeism, and can lower overall healthcare costs for businesses. Taking proactive steps to support dental wellness demonstrates an employer’s commitment to employee well-being and organizational success.

Cigna's stop-loss stabilizes while PBM margins tighten

By Allison Bell – Executives at Cigna say they're happy with the performance of the company's stop-loss insurancebusiness but expect profit margins at the company's big Express Scripts pharmacy benefit manager business to be narrower for the next two years. Employers use stop-loss insurance to protect self-insured health plans against catastrophic risk. Product issuers said last year that claims were much higher than expected, and they talked about plans to increase rates and get tougher on underwriting. Cigna did raise rates, and raising rates worked to get the performance of the stop-loss business under control, according to Brian Evanko, Cigna's chief operating officer. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Stop-Loss Insurance Performance Improvement: Cigna's stop-loss insurance business has stabilized after the company increased rates earlier in the year. This repricing has helped control the performance of the stop-loss segment, and Cigna expects margin expansion in this business by 2026. Despite the rate increases, customer retention remained typical, indicating employer acceptance of the changes.

2. Pharmacy Benefit Manager (PBM) Margins Tighten: While about 97% of Cigna's PBM customers are renewing their contracts, the company has accepted narrower profit margins to retain three major clients: the U.S. Department of Defense, Centene, and Prime Therapeutics. These clients represent approximately $90 billion in annual revenue. Additionally, Cigna is investing in system upgrades to transition from rebate-based to service-fee-based pricing, which may further pressure margins in the near term.

3. Strategic Shift in Pricing Model and Business Outlook: Cigna aims to move all enrollees in its fully insured plans to a service-fee-based pricing model by 2027 and about half of all its business by the end of 2028. The company reported strong financial results for the third quarter of 2025, with net income rising to $2 billion on $70 billion in revenue. However, the total number of people covered decreased slightly, with a small decline in insured employer plans but a modest increase in self-insured U.S. employer plans.